About 80% of sexually active women will become infected with the Human Papillomavirus (HPV), causing genital warts and cervical cancer. In most women, these viruses disappear on their own after a while. However, in a small proportion, certain types of the virus persist and evolve into cervical cancer, the second most common cancer in women, and it can be detected with a Pap smear.
There is usually fifteen years or more between infection and cervical cancer development. HPV can also cause other cancers such as penile cancer, vulva/vaginal cancer, anal cancer & throat cancer. Throat cancer is mainly linked to oral sex. Infection with HPV can also reduce fertility.
Because HPV can really cause a lot of trouble, all-girls (and recently all boys) are vaccinated in Belgium for more than 10 years (thank you to our partner Sensoa). For information about the availability of the vaccine in your country, please check this website. This vaccine is usually offered in secondary school. The vaccination is beneficial if you have not been in contact with the virus. Therefore, to avoid awkward conversations with parents once they become sexually active, all girls and boys must be encouraged to get vaccinated. In addition, vaccination also works better when you are younger. If you are younger than 15 years old, 2 vaccinations with an interval of 6 months are sufficient. If you are older than 15 years, you need three vaccinations. Most infections occur during the period of the first sexual relations. But vaccination is possible in women and men between 9 and 45.
Do you need to have another smear test if you have been vaccinated? Yes. Current vaccines do not protect against all types of HPV; therefore, they do not provide complete protection against cervical cancer development. That is why WHO recommends having a Pap smear test if you are above 30, even if they have been vaccinated against HPV. This is necessary to detect abnormalities caused by other types of HPV against which the vaccines do not protect.
According to the survey, 38% of the Isala participants reported to be vaccinated, 37% not, and 25% did not know. This makes us suspect that it is quite possible to explain more about this vaccine’s importance and function to secondary school boys and girls.
What if you – like me – belong to a generation where the vaccine did not exist yet? Even then, vaccination can sometimes be useful, although opinions are divided. Even if you have already been infected with one of the types, the vaccination can still protect against the other HPV type(s). After all, the chance that we have become infected with all types of HPV that cause cancer is minimal. But this should always be discussed with your doctor. In general, for those over 18 years old, there is no reimbursement of the vaccine via the national health insurance fund. The risk depends on your lifestyle and sexual partners. But even with a steady partner, it can be useful. After all, with aging, your body produces fewer antibodies against viruses, thus also against HPV. With the vaccine, you will receive an extra dose of antibodies to fight the virus.
According to the Isala microbiome data, being vaccinated against HPV was associated with lower levels of the Gardnerella-module, so this could be a novel -unprecedent- beneficial side effect of the vaccination.
Is there anything else you can do to protect yourself preventively against HPV? Unfortunately, the condom only partially protects because the HPV is present in the entire intimate area and can therefore just as easily be transferred during lovemaking without penetration. Another interesting option is the use of probiotics or extra lactobacilli. Previous research done by our Isala-advising general practitioner Véronique Verhoeven suggested that certain probiotics might help prevent cervical cancer. The study was done on fifty participants with an increased risk of cervical cancer. The participants had to take a probiotic or a placebo for six months. After six months, it turned out that the smear of the probiotic group showed fewer abnormal cells. Still, more clinical research is certainly needed to confirm this research. This is also an active research area of the Isala team. So we start looking for new interesting lactobacilli that hopefully work even better than the already known probiotics.
The Isala survey showed that 70% of the participants regularly eat yogurt, 8% regularly take dairy products such as Yakult and Actimel enriched with probiotics, and 8% take probiotics in capsules. This probably without considering whether this could possibly have an effect on the vaginal microbiome. Almost 5% of the Isala women did indicate that they took probiotics when a vaginal infection was detected. Still, we could not determine from the answers whether this was specific for HPV.